Blow Fly Larvae Mouth Hooks Cause Infiltration of Wound Exudate Along with Larvae Secretions into the Tissues Beneath the Wound and the Bloodstream, but Fortunately Sepsis Does not Occurred at all

BACKGROUND AND OBJECTIVESWhen there is little exudate in the wound, the larvae orientation is horizontal, but when there is significant exudate in the wound, the larvae orientation is vertical. In the vertical orientation larvae will close their first pair of stigma and will breath with their hind stigma.However,at frequent intervals of two to three seconds, the larvae ,especially during the third instar stage, will strike the wound with their mouth hooks and will scrape the wound surface with their mouth hooks, and in the process will pierce some capillaries, which will lead to small quantities of wound exudate along with larval secretions to reach the tissues beneath the wound and the capillaries.Furthermore,when larvae are in a horizontal orientation, any movement of larvae(first piercing the wound surface with their mouth hooks and then moving further in)will create small openings and transfer wound exudate together with all larval secretions into the tissues below the wound and into the human blood circulation. Because the mouth hooks do not permit the larvae to close its mouth, the oral cavity is always open and as soon as any openings appear in the wound surface, the secretions from the larvae mouth, ammonia and wound exudate will enter the tissues beneath the wound and also human blood circulation.Every Physician is concerned about the infiltration of wound exudate into the tissues below the wound and into the bloodstream.However,since millions of years ago the unique behavior of blowfly larvae and other facultative myiasis fly larvae have caused both wound exudate and all secretions of larvae to infiltrate into the tissues below the wound and the blood circulation. Why doesn’t the unique larvae behavior cause sepsis?Certainly, this phenomenon that exists in maggot therapy is a good key to prevent and cure blood infection in humans.MATERIALS AND METHODSDuring the entire time using maggot therapy treatment method, we observed that as soon as the larvae reached the third stage, and the mouth hooks reached the full size, a slight bleeding was observed in the wound area, as the result of mouth hooks kick the capillary wall, causing wound exudate and all larval secretions to be entered the bloodstream, and tissues beneath the wound.Furthermore, considering that the larvae do not have any rest during all seconds of day and night, and every movement of the larvae requires the mouth hooks to be entered the wound area, therefore the patients suffer severe pain.We must emphasize that when the larvae are small (first and second stage), due to the small size of the mouth hooks, slight bleeding (fresh blood) is never seen in the wound. ۴۲۳Considering, that the wall of capillaries is very rigid, therefore the impact of mouth hooks causes the capillaries to be punctured and the wound exudate and secretions of the larvae entered to the human blood stream and tissues beneath the wound.Ammonia is one of the most important secretions of blowfly larvae. If more than the usual number of larvae are released to the wound in Maggot Debridement Therapy (MDT) , the elevated levels of Ammonia in the bloodstream will cause “Ammonia fever. If the maggot therapist reduces the number of maggots, within approximately an hour the patient’s fever will subside. So the larvae’s unique behavior is interconnected with the human body’s response: ammonia and other larval secretions together with wound exudate reach the tissue beneath the wound and human bloodstream. How does ammonia enter the bloodstream? Ammonia reaches the blood stream by the unique behavior of the larvae. When ammonia can enter the blood circulation through the actions of the larvae mouth hooks, surely wound exudate and all other larval secretions can also enter the blood stream.RESULTS AND DISCUSSIONFor decades, blow fly larval secretions and excretions have been recognized to kill microbes. Much progress has been made over the past ۲۰ years, but still we probably do not know all of innate microbial compounds produced by this fly. Still it is time that we started thinking about microbial killing beyond the value to the fly or even to the wound; we should consider the value of antimicrobial to the living host. Microbes easily and frequently enter the body through perforations in the skin, areas where the skin integrity has been disrupted, such as a skin wound. Once the microbe gains access to the blood stream(called bacteremia),it can spread throughout the entire body ,causing significant systemic complications(called sepsis)such as hypotension, cardiac failure, and death. Larval secretions not only kill microbes in the wound, but in doing, surely prevent bacteremia and sepsis. Not only do the maggot secretions and excretions dissolve the necrotic tissue where those microbes live and produce, but they also spill over the wound edges, destroying the microbes in the neighboring regions and bloodstream.CONCLUSIONThe larval behavior will elevate the human immune system, because a small number of microbes continuously enter the tissue beneath the wound and enter the human bloodstream, the human immune system can fight efficiently against various microbes, also the larvae’s vital secretions will kill microbes in tissues below the wound and in the bloodstream.The unique larval behavior will cause the reconnection of the wound to the human body. In fact, chronic wounds gradually cause the isolation of the wound from the rest of human body, but this beneficial process will cause all body parts, especially the human bloodstream, to be exposed to various bacteria and other pathogens that may exist in the wound.In natural myiasis where from sunrise to sunset adult flies transfer all sorts of microbial species of nearby environment to the wound, creatures will find the ability to defend against various pathogens.Furthermore,in natural myiasis the vital secretions of adult flies will be released into the wound.Obviously blow fly can and do cure wounds in all creatures of the world, including mammals,birds,reptiles,etc.The discussion here is centered only on human wounds and MDT.Clearly, the mechanics of the mouth hooks of blow fly larvae cause their oral secretions and ammonia in combination with wound exudate to reach the tissue beneath a wound site and blood stream of the host, be in human or animal.